Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium.
Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
Semin Arthritis Rheum. 2014 Apr;43(5):627-31. doi: 10.1016/j.semarthrit.2013.09.004. Epub 2013 Oct 5.
To compare in daily clinical practice the reliability of matrices that forecast rapid radiologic progression (RRP) at year one, at year two, and over 2 years in patients with early rheumatoid arthritis (RA).
Overall, 74 early RA patients with X-rays of hands and feet at baseline, year one, and year two were included. Initial DMARD combination therapy with steroids (ICTS) or DMARD monotherapy (IMT) was initiated according to patients' RA severity, based on rheumatologist opinion. The images were scored via the modified Sharp/van der Heijde (SvH) method. A total Sharp score progression of equal or higher than five per year was considered RRP. Six matrices were tested: ASPIRE CRP/ESR matrices, the BEST matrix, two SWEFOT matrices, and the ESPOIR matrix. Patients were placed in each of them yielding a RRP probability. The performance was tested by Area Under the Curve analysis reflecting the predictive value.
Four patients developed RRP in year one, five in year two, and four over 2 years. With regard to face validity, the predicted probability did not correspond to the risk in reality: the one ICTS patient who developed RRP over 2 years was always found in the lowest RRP categories of all matrices. The ASPIRE CRP matrix yielded at least a moderate predicting value for the three time points. The other matrices showed moderate to no predicting value.
The performance of all matrices was disappointing and it is impossible to fully rely on the existing matrices in daily clinical practice.
比较在日常临床实践中，预测早期类风湿关节炎（RA）患者一年内、两年内和两年以上快速放射学进展（RRP）的矩阵的可靠性。
共纳入 74 例基线、一年和两年时手部和足部 X 射线的早期 RA 患者。根据患者的 RA 严重程度，根据风湿病医生的意见，初始联合使用疾病修饰抗风湿药物（DMARDs）联合类固醇（ICTS）或 DMARD 单药治疗（IMT）。采用改良的 Sharp/van der Heijde（SvH）评分方法对图像进行评分。每年 Sharp 评分进展等于或高于 5 被认为是 RRP。测试了六个矩阵：ASPIRE CRP/ESR 矩阵、BEST 矩阵、两个 SWEFOT 矩阵和 ESPOIR 矩阵。将患者分配到每个矩阵中，得出 RRP 概率。通过反映预测价值的曲线下面积分析来测试性能。
4 例患者在一年内发生 RRP，5 例在两年内发生 RRP，4 例在两年以上发生 RRP。就表面效度而言，预测概率与现实风险不符：在两年以上发生 RRP 的唯一 ICTS 患者在所有矩阵中总是处于最低 RRP 类别。ASPIRE CRP 矩阵对三个时间点均具有至少中度的预测价值。其他矩阵显示出中度或无预测价值。
所有矩阵的性能都令人失望，因此在日常临床实践中无法完全依赖现有矩阵。
